Tension pneumothorax (tension pneumothorax) is a life-threatening condition that is present in 0.2-1.7% of civilian trauma patients and up to 4% of battlefield casualties. This condition can result from a laceration of the lung, creating a parenchymal air leak with no means of evacuation. Consequently, the patient can manifest with severe hypoxia, hypercarbia, and/or cardiovascular collapse as increasing pressure in the hemithorax creates ipsilateral lung collapse and impedance of venous return to the heart.
Previous data from the Vietnam War suggested that up to 33% of preventable deaths on the battlefield resulted from tension pneumothorax. In civilian patients, the reported incidence of tension pneumothorax varies from 0.2% to 1.7%. In some cases, about 1.5% of blunt trauma patients can undergo needle decompression for suspected tension pneumothorax.
Despite its lethality, tension pneumothorax can be reversed with effective thoracic decompression. The current standard pre-hospital treatment of tension pneumothorax, as described in the 9th edition of the Advance Trauma Life Support (ATLS) Student Course manual, is immediate decompression by inserting a large-caliber needle, most commonly a 5-cm 14-gauge angiocatheter, into the second intercostal space in the mid-clavicular line of the affected hemithorax. However, this technique has been repeatedly shown to be ineffective and unsafe, with failure rates ranging from about 40% to about 64%. Extrathoracic catheter placement and catheter kinking are the most commonly observed technical failures. Accordingly, improvements to devices and methods of treating tension pneumothorax are desirable.
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